MEDICARE: AMANDA REISTER COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1982433173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA REISTER COUNSELING LLC

Provider Business Mailing Address
First Line	:	2801 MASEFIELD DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1948
Country	:	US
Telephone Number	:	248-346-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2242 S TELEGRAPH RD STE 206
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0218
Country	:	US
Telephone Number	:	248-346-6145
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. AMANDA ELIZABETH REISTER
Credential	:	LLC
Telephone Number	:	248-346-6145

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	01/21/2025

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